PROFILE
EXAMINATION REGISTRATION
TYPICAL MICROFINANCE INDIVIDUALS AND
ORGANIZATIONS CITI – VIETNAM 2014
CMA 2014
(For microentrepreneurs)
Full name of microentrepreneur:
Phone number:
Microfinance Organizations/Programs that granted you a loan: :
Full name of credit management staff:
Province/ City:
Profile ID: DNVM……………
Total points: …………………..
Enclosed the following documents in the attendance profile:
□A written commitment to allow the use of images and information on the mass media
□Photo identity card
□Image or video to prove your business production activities
General Introduction about CMA Program
Objects: Microentrepreneurs are customers of microfinance institutions or microfinance programs /
projects. They are poor / low-income people when they started to get a loan (according to the criteria of the
state: rural and mountainous areas’ income is under 400.000 VND/month, urban areas’ income is under
500.000 VND / month). They are production owners or operators with small-scale businesses with a total
asset not exceeding 2 billion VND at the current time.
Provisions and conditions of participants
1. Invalid and rejected profiles if:
(1) Information in CMA 2014 registration profile is incorrect compared with the results of the
evaluation of the CMA Council of Jury in 2014;
(2) Detection of erroneous information in the profile enrolled in CMA 2014;
(3) Profiles attending contain contravention to the regulations about participants, contents and submit
profiles deadlines under Announcements of CMA 2014.
2. Organizing Committee and CMA Council of Jury in 2014 are NOT responsible for the
following issues:
(1) Complaints related to the selection of the candidates within their own microfinance institutions;
(2) The missing CMA 2014 attendance records due to microfinance institutions sending records to
the Department of CMA 2014
(3) The complaints related to the use and distribution of prize money awarded. In case of complaints
about any organization requiring to divide the received awards among other organizations or
individuals, the organizers of CMA 2014 will have to publish that information on the website and the
respective organization will not be accepted to participate in the CMA program next year.
3. Decision of the Jury CMA 2014 is the final decision.
Conditions for participation in the CMA program
CMA Program participants should satisfy all the following conditions. Please check by marking an X in the
appropriate box:
Citizens of the Socialist Republic of Vietnam and have production or commercial activities, within the
territory of Vietnam
Owner and operator of the facility / business
Household with low- income / living in poverty at the start of the loan
Having a loan from a microfinance organization dedicated to production and do business.
Not have been recognized in a business program accredited by Citi Microfinance - Vietnam in the years
from 2007 to 2013
Information about microentrepreneurs and facility / business households
1. Full name: ___________________________________________________________________
2. Date of Birth: ________________________________________________________________
3. Gender:□ Male□ Female
4. Participants
- Ethnicity: □ Kinh
□ Ethnic Minority, specify what________________________
- Poor households (according to the criteria of the State) □ Yes□ No
If yes, ID number of the poor certification:……………)
- HIV carrier: □ Yes
□ No
-Disability carrier:
□ Yes
□ No
5. Identity card number (01 copy attached): _______________________________________
6. Number of dependents in your family:_______ people
7. Educational level: ______________________________________________________________
8. Diploma:
______________________________________________________________________________
9.Contact Information:
Address:
Phone number:_____________Mobile Phone (if available): ______________________________
E-mail (if available): _____________________________________________________________
10. Kind of production, business at the moment (Please mark X in the box option)
□Only agriculture
□Agriculture as secondary □Non- agriculture
activity
□Production and small business □Other activity
Please specify: _________________________________________________________________
11. Short description of the participant (Describe your situation with no more than 500 words,
please refer to the example below)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Microentrepreneur Tran Thi A. 1964,Women's Support Fund Economic Development,Binh Chau,
Thanh Trung, Tien Giang.
Ms. A was previously a poor household with low-income. Beginning in 2007 with a loan amount
of 1,500,000dong to develop and export weaved clothes. Initially, it was difficult for her business
but determined, she gradually accumulated experience and existing production facilities to create
a regular business with 36 regular employees and 18 seasonal employees. Her current income is
78 million VND / year, with a total asset value in 2012 of 220 million VND.
Part 1: Establishing Process of Business
(The marked part)
1. Location of your business : (Please mark X in the box option)
□ Remote, high mountain region □ Plain, midland or coastal region
□ Cities, towns
□ Border or island region
2. What changes occurred in your production work/business?
Content
2a. Production and sale of products / services which are not available in the market.
(If yes, please specify)
Answer
□Yes
□No
_______________________________________________________________
_______________________________________________________________
2b. Production and sale of products / services which are available in the market but you
changed the design, quality and usage
(If yes, please specify)
□Yes
□No
_______________________________________________________________
_______________________________________________________________
2c. Production and sale of products / services which bring more distinctive benefit to
customers rather than normal ones. (If yes please specifiy)
□Yes
□No
(Example: You created an added value for the clients; for example, more efficient
product, more cost-saving products)
_______________________________________________________________
_______________________________________________________________
2d. Diversification of the product, the manufacturing sector business
(For example: add new pet farming, plant new trees, sell more new items since the
□Yes
□No
production started) (If yes, please specify)
______________________________________________________________________
__________________
____________________________________________________
____________________________________________________
3. Did you study the situation on the market before to start your production, business or not?
(If yes, please describe briefly)
Points
(Only
Content
Answer
for
Jury)
Points
(Only fo
Jury)
3a. Find out in advance about the location of seed supply stores, feed,
medicines for pets, plants ... which provides information to identify potential
partners, competitors in present and future? (Please
explain)________________________________________________________
__________________________________________________
□Yes
□No
3b. Find out if the residents in the commune / district prefer toyou’re your
products and use your services or not? (Please
explain)________________________________________________________
__________________________________________________
□Yes
□No
3c. Find out other considerations and issues (where sales are convenient for
buyers ...)? (Please
explain)________________________________________________________
__________________________________________________
□Yes
□No
4.
No
Supply / skills / capital / location
4a. Funds (Please fill the following table):
Capital Source
1
Own capital
2
Microfinance loans
3
Commercial bank loans
4
Policy bank loans
5
Debt People's Credit Fund
6
External borrowing
(lenders with high interest
rates)
7
Other sources
At the beginning of borrowing
(fill the year starting borrowings
in)
2013
(đồng)
Points (Only for
Jury)
4b. Scaling: after a production and business period, have your activities been extended or
not?
□Yes
□No
(For example: your products / services were sold to the adjacent commune / district) (Please
specify)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
4c. Did loans (if any) from microfinance organizations or programs have an impact on your
business activities?
(maximum 500 words)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
5. 5. Difficulties in setting up business
5a. Did you have any difficulties when you started your production business?
Content
Answer
5.a1. Difficulties in finding material suppliers
□Yes
□No
5.a2. How to transport the production from the production place to the
selling place?
□Yes
□No
□Yes
□No
5.a3. Not knowing what to sale, what to plant, what animals?
5.a4.Who is going to buy?
5.a5. Lack of technical knowledge
(do not know how to farming, processing ...)
5.a6. Lack of skills (Do not persuade family members to follow your
business plan; Do not run your business well in the market).
5.a7. Lack of funds
5.a8. Lack of equipment
(fields, gardens, shops, factories, machinery)
5.a9 Other difficulties (lack of employees, epidemics, floods ...)
_______________________________________________________
_______________________________________________________
Points
(Only
for Jury)
□Yes
□No
□Yes
□No
□Yes
□No
□Yes
□No
□Yes
□No
□Yes
□No
5b.Did you solve the above problems and what did you learn from this experience? (maximum
500 words ).
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Part 2: Model and scale of Businesses
(Marked Part)
A. Sustainable Operation
1. a) Did your Business Unit register your business?
Yes
No
(If yes, please answer the questions below)
Which agencies did issue the license for your business (commune, district or
province)?_______________________________________________________________________
______________________________________________________________________
Have Business licenses been issued in time?
_______________________________________________________________________________
_______________________________________________________________
b) The degree of observance of the law in the production and trade:
•Payment of taxes:
• Respect of employees’ rights (health insurance, labor protection ...):
2. Have you been engaged in?
Content
2a. Compulsory savings
2b. Voluntary savings
2c. Savings Groups (Hụi, họ)
2d. Buying microinsurance
Points
(Only for
Jury)
Answer
□Yes/ □ No
□Yes/ □ No
□Yes/ □ No
□Yes/ □ No
□Yes/ □ No
2e. Savings in other forms (please specify)
_____________________________________________
3.Please state your business plan for the next 2 years (2015-2016) (maximum 500
words)__________________________________________________________________________
_______________________________________________________________
_______________________________________________________________________
B. Operating Performance
B1. Economic Performance
1. Please fill the following table:
Unit: VND
No
Ratio
1
Revenue
2
Expenses
3
Profits
2013
Points ( Only for Jury)
2. Please indicate the changes in your activity after starting production?
Unit: VND
No
Criteria
1
Annual household
income
2
Annual
expenditures
Annual savings
3
4
5
The value of total
assets (including
the value of
housing,
transportation,
machinery
manufacturing
....)
The increase in
your business
Scale
When the business
started
(in .........)
(a)
Current time
(2013)
The
difference
(b)
(c = a-b)
Points
(Only for
Jury)
B2. Social Performance
1. Contribution to the community: (Please mark X in the appropriate box)
□ Charitable contributions and support to social organizations, victims of natural disasters,
protection of environment...
(maximum 500 words)
________________________________________________________________________
________________________________________________________________________________
________________________________________________________________
________________________________________________________________________
________________________________________________________________________
□Reduce pressure on the society (self-assurance own life, family and helping those around)?
(maximum 500 words)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
□ Sharing production models and business support to spread them to those around them (maximum
500 words)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. During the business’ proceedings, did you have links with other organizations?
□ Yes
□ No
If yes, please describe which kind of link: ______________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________________
3. Positive contribution:
a. Did your business contribute in reducing unemployment? :
Content
3a1.Creating jobs for family members
3a2. Creating jobs for people outside the family
o Number of regular workers: ______ people
o Number of partime workers: ______ people/______
amount of products
3a3. Number of employees:
Answer
Points (
Only for
Jury)
□ Yes / □ No
□ Yes / □ No
Number of workers at the starting time : ..................... people
Regular workers in current time: ............ people
4.Did your production model participate in environmental protection and adaptation to
climate change? (6points)
a. Did your Business activities increase the pollution of the environment? (Please specify)
□ Yes □ No
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b. Which methods to protect the environment did you apply to your business activities (Please
specify in case of your business activities had a negative effect on the environment): ____________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c. Methods to improve responses / adaptation to climate change:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Part 3: Other criteria
(Marked Part)
Please answer the following questions:
a. How have you heard about the 2014 CMA program? ___________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b. Do you have any comment about the 2014 CMA program? (maximum 500 words)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c. If you win the 2014 CMA program, how do you intend to use this money for? (maximum 500
words)__________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I understand and agree on the criteria and conditions for participating in the 2014 CMA
program and I committed in providing an honest content and correct profile.
Date:
Participant
(Signature and full name)
Confirmation of MFIs
(Signature and full name)
Deadline for reception on 15.08.2014 (by postmark)
Application to attend 2014 CMA program should be sent to the following address:

Vietnam Microfinance Working Group (VMFWG)

Address: 2nd Floor, House No. 23, Street Hang Voi, Hoan Kiem District, Hanoi

Tel: (84-4) 39352060, 0903229027 - Fax: (84-4) 39352059

Email: bantochuccma2014@gmail.com (CMA 2014 Organizing Committee can only
receive attendance application forms and answer questions sent to this email address,
attendance application forms sent to other email addresses will not be accepted)
Thank you!